Operator s Manual Avant 2120 Pulse Oximeter and Noninvasive Blood Pressure (NIBP) Monitor 0123 English
CAUTION: Federal law (USA) restricts this device to sale by or on the order of a licensed practitioner. Consult Instructions for Use. Nonin reserves the right to make changes and improvements to this manual and the products it describes at any time, without notice or obligation. Nonin Medical, Inc. 13700 1st Avenue North Plymouth, MN 55441-5443, USA + 1 (763) 553-9968 800-356-8874 (USA and Canada) Fax: + 1 (763) 553-7807 E-mail: info@nonin.com Nonin Medical AB Fibervägen 2 82450 Hudiksvall, Sweden +46 650 401500 (Europe) Fax: +46 650 401514 E-mail: infointl@nonin.se www.nonin.com EC REP Authorized EC Representative: MPS, Medical Product Service GmbH Borngasse 20 D-35619 Braunfels, Germany References to Nonin in this manual imply Nonin Medical, Inc. Nonin, Flexi-Form, FlexiWrap, PureLight and nvision are registered trademarks or trademarks of Nonin Medical, Inc. Microsoft and Windows are registered trademarks of Microsoft Corporation. 2011 Nonin Medical, Inc. 7932-001-02
Contents Indications for Use... 1 Contraindications... 1 Warnings... 1 Cautions... 2 Guide to Symbols... 4 Displays, Indicators, and Controls... 5 Parameter Displays... 5 %SpO 2 Display... 5 Pulse Rate Display... 5 Systolic Pressure Display... 5 Diastolic Pressure Display... 5 MAP (Mean Arterial Pressure) Display... 6 Numeric LEDs... 6 Indicators and Icons... 7 Display Panel Buttons... 9 Operating the Device... 11 Installing the Batteries... 11 Verifying Operation... 12 Alarm Limit Defaults... 12 NIBP and %SpO 2 Functions... 12 Operator Functions... 13 Taking Blood Pressure Measurements... 13 NIBP Cuff Selection... 13 NIBP Cuff Placement... 13 Automatic and Demand NIBP Measurements... 15 Calibrating Blood Pressure... 16 Advanced Features... 17 Button Combinations... 17 DIP Switches... 17 Quick Reference for Printing... 19 Communication... 20 Memory Features... 20 Using nvision Data Management Software... 20 Real-Time Patient Data Output... 21 Care and Maintenance... 23 Cleaning... 23 Cleaning the Blood Pressure Cuff... 23 Alarms and Limits... 24 Alarms... 24 i
Contents (Continued) High Priority Alarms...24 Medium Priority Alarms...24 Error Codes...24 Watchdog Alarm...26 Informational Tones...26 Alarm Summary...26 Setting and Changing Volume and Alarm Limits...27 Setting or Changing SpO 2 and/or Pulse Rate Alarm Limits...27 Setting or Changing Systolic, Diastolic, and MAP Alarm Limits...27 Setting or Changing Alarm and Pulse Volumes...27 Silencing Alarms...28 Setting and Changing NIBP Settings...28 Setting or Changing Automatic NIBP Cycle Time...28 Setting or Changing Initial NIBP Cuff Inflation Pressure...28 Parts and Accessories...29 Service, Support and Warranty...30 Warranty...30 Troubleshooting...32 Technical Information...34 Manufacturer s Declaration...34 Equipment Response Time...38 Testing Summary...39 SpO 2 Accuracy Testing...39 Pulse Rate Motion Testing...39 Low Perfusion Testing...39 NIBP Testing Summary...39 Specifications...40 ii
Figures Figure 1. Avant 2120 Front and Back View... 5 Figure 2. Installing the Batteries... 11 Figure 3. Proper Cuff Placement... 14 Figure 4. Connecting the Blood Pressure Cuff and Finger Clip Sensor... 15 Figure 5. DIP Switches... 18 Figure 6. RS232 Connector Port... 21 iii
iv Tables Table 1. Symbols... 4 Table 2. DIP Switches... 17 Table 3. Error Codes... 24 Table 4. Alarm Summary... 26 Table 5. Electromagnetic Emission... 34 Table 6. Electromagnetic Immunity... 35 Table 7. Guidance and Manufacturer s Declaration Electromagnetic Immunity... 36 Table 8. Recommended Separation Distances... 37
Indications for Use Indications for Use The Nonin Avant 2120 Pulse Oximeter and NIBP Monitor is a portable device indicated for use in measuring and displaying functional oxygen saturation of arterial hemoglobin (SpO 2 ), pulse rate, and blood pressure of adult and pediatric patients in hospitals, medical facilities, and subacute environments. The Avant 2120 is intended for spot-checking and/or continuous monitoring of patients during both motion and no-motion conditions, for patients who are well or poorly perfused. Its functions may be used separately or simultaneously. The blood pressure monitor is intended for noninvasive monitoring of the blood pressure of adult and pediatric patients in hospitals, medical facilities, and subacute environments. It is intended for attended care and may be used for spot-checking. The device should be used for patients with arm circumferences of 18-42 cm. Contraindications Do not use this device in an MR environment. Do not use this device in an explosive atmosphere. The pulse oximeter portion of this device is not defibrillation proof per IEC 60601-1. The blood pressure monitor is not intended for use with neonates. Warnings This device is intended only as an adjunct device in patient assessment. It must be used in conjunction with other methods of assessing clinical signs and symptoms. This device must be able to measure the pulse properly to obtain an accurate SpO 2 measurement. Verify that nothing is hindering the pulse measurement before relying on the SpO 2 measurement. Operation of this device below the minimum amplitude of 0.3% modulation may cause inaccurate results. General operation of this device may be affected by the use of an electrosurgical unit (ESU). The use of accessories other than those specified in the Parts and Accessories List may result in increased electromagnetic emission and/or decreased immunity of this device. This device should not be used adjacent to or stacked with other equipment. If adjacent or stacked use is necessary, the device should be observed carefully to verify normal operation. Do not use a damaged sensor. As with all medical equipment, carefully route patient cables and connections to reduce the possibility of entanglement or strangulation. This device turns off after approximately 30 minutes when in low battery mode. 1
Indications for Use Warnings (Continued) The battery pack must be installed at all times while the device is operating, even when operating on AC power. The audible alarms and memory will not function if batteries are removed from the device. Do not use the device without batteries. Use this device only with Nonin-specified power supplies. Do not use this device in or around water or any other liquid, with or without AC power. To comply with relevant product safety standards, ensure that all alarm volumes are set appropriately and are audible in all situations. Do not cover or otherwise hinder any speaker openings. This device is a precision electronic instrument and must be repaired by qualified technical professionals. Field repair of the device is not possible. Do not attempt to open the case or repair the electronics. Opening the case may damage the device and void the warranty. To obtain accurate results, and for important safety reasons, the blood pressure cuff must only be placed on the patient s arm. Use only Nonin-specified blood pressure cuffs and hoses with the device. Using other cuffs might result in inaccurate readings or inability to operate the device. Use only Nonin-branded PureLight pulse oximeter sensors. These sensors are manufactured to meet the accuracy specifications for Nonin pulse oximeters.! Cautions This equipment complies with IEC 60601-1-2 for electromagnetic compatibility for medical electrical equipment and/or systems. This standard is designed to provide reasonable protection against harmful interference in a typical medical installation. However, because of the proliferation of radio-frequency transmitting equipment and other sources of electrical noise in healthcare and other environments, it is possible that high levels of such interference due to close proximity or strength of a source might disrupt the performance of this device. Medical electrical equipment needs special precautions regarding EMC, and all equipment must be installed and put into service according to the EMC information specified in this manual. Portable and mobile RF communications equipment can affect medical electrical equipment. If this device fails to respond as described, discontinue use until the situation is corrected by qualified technical professionals. Do not autoclave or immerse this device in liquid or use caustic or abrasive cleaning agents. Batteries may leak or explode if used or disposed of improperly. In some circumstances, the device may interpret motion as good pulse quality. Minimize patient motion as much as possible. Inspect the sensor application site at least every 6 to 8 hours to ensure correct sensor alignment and skin integrity. Patient sensitivity to sensors and/or double-backed adhesive strips may vary due to medical status or skin condition. Do not place liquids on top of this device. Do not immerse this device or sensors in any liquids. 2
Indications for Use! Cautions (Continued) Follow local, state and national governing ordinances and recycling instructions regarding disposal or recycling of the device and device components, including batteries. When using the 300PS-UNIV power supply, ensure that the AC cord is plugged into a grounded outlet. To prevent potential loss of monitoring, do not use ear clip or reflective sensors on pediatric or neonatal patients. In compliance with the European Directive on Waste Electrical and Electronic Equipment (WEEE) 2002/96/EC, do not dispose of this product as unsorted municipal waste. This device contains WEEE materials; please contact your distributor regarding take-back or recycling of the device. If you are unsure how to reach your distributor, please call Nonin for your distributor s contact information. Data is overwritten ONE RECORD AT A TIME so if the entire memory is filled with a single record, portions of that record will be deleted when a new record begins. A functional tester cannot be used to assess the accuracy of a pulse oximeter monitor or sensor. All parts and accessories connected to the serial port of this device must be certified according to at least IEC 60950 or UL 1950 for data-processing equipment. This device is designed to determine the percentage of arterial oxygen saturation of functional hemoglobin. Factors that may degrade pulse oximeter performance or affect the accuracy of the measurement include the following: excessive ambient light excessive motion electrosurgical interference blood flow restrictors (arterial catheters, blood pressure cuffs, infusion lines) moisture in the sensor improperly applied sensor incorrect sensor type The device may not work when circulation is reduced. Warm or rub the finger, or ensure proper positioning of tubing/device. This device s display will go blank after 30 seconds of no readings or poor readings. Do not place DIP switch 1 in the UP position unless device calibration is intended. poor pulse quality venous pulsations anemia or low hemoglobin concentrations cardiogreen and other intravascular dyes carboxyhemoglobin methemoglobin dysfunctional hemoglobin artificial nails or fingernail polish 3
Guide to Symbols Guide to Symbols This table describes the symbols that are found on the Avant Model 2120. See section titled Displays, Indicator, and Controls for detailed information about functional symbols. Table 1. Symbols Symbol Description/Function Consult Instructions for Use Follow Instructions for Use Defibrillation-Proof Type BF Applied Part (Patient isolation from electrical shock). Applies to NIBP. Type BF Applied Part (Patient isolation from electrical shock). Applies to pulse oximeter. C U L CLASSIFIED SN US 0123 UL Mark for Canada and the United States with respect to electric shock, fire, and mechanical hazards only in accordance with UL 60601-1 and CAN/CSA C22.2 No. 601.1. CE Marking indicating conformance to EC directive No. 93/42/EEC concerning medical devices. Serial Number Indicates separate collection for electrical and electronic equipment (WEEE). IPX2 %SpO 2 Protected against vertically falling water drops when enclosure is tilted up to 15 degrees, per IEC 60529. %SpO 2 Display Pulse Rate Display Signal Output 4
Displays, Indicators, and Controls Displays, Indicators, and Controls This section describes the displays, indicators, and controls used on the Avant 2120. MAP mmhg Parameter Displays %SpO 2 Display Figure 1: Avant 2120 Front and Back View Numeric light-emitting diodes (LEDs) on the upper left-hand corner of the device display blood oxygen saturation in percent. Pulse Rate Display The pulse rate display is the lower numeric display on the upper left-hand corner of the device (identified by the symbol). This 3-digit LED display shows the pulse rate in beats per minute. Systolic Pressure Display The systolic display is a 3-digit LED display near the upper right-hand corner of the device. The Systolic number displayed represents the blood pressure in mmhg during contraction of the ventricles. Diastolic Pressure Display The diastolic display is a 3-digit LED display in the middle right-hand side of the device. The Diastolic number displayed represents the blood pressure in mmhg when the ventricles are relaxed. 5
Displays, Indicators, and Controls MAP (Mean Arterial Pressure) Display The MAP display is a 3-digit LED display near the middle right-hand side of the device. The MAP number displayed is a calculated value in mmhg, based on measurements of systolic and diastolic pressure: MAP = 2/3 diastolic + 1/3 systolic NOTE: LED means light-emitting diode. Numeric LEDs Numeric LEDs appear for SpO 2, Pulse Rate and blood pressure data, and for time and date displays, cuff pressure, volume and NIBP history review. There are five 3-digit multi color numeric LEDs on the device. They are used for SpO 2, pulse rate, and blood pressure displays. Green numeric LEDs display %SpO2 and pulse rate values. When setting the device, the LEDs also display values for alarm limits, volume, and date and time settings. Amber slowly blinking LEDs indicate a medium priority (equipment) alarm. Red, rapidly blinking LEDs indicate a High Priority patient alarm. There is also a four-digit, green, numeric LED on the device. It is used primarily to display date and time information, adjust volumes, adjust the auto NIBP cycle time, and set the initial NIBP cuff pressure. 6
Displays, Indicators, and Controls Indicators and Icons Pulse Oximeter Sensor LED The Pulse Oximeter Sensor LED indicates when a sensor has become disconnected, has failed, is misplaced or is not compatible with this monitor. Pulse Strength / Battery Capacity Bar Graph LED This 10-segment multi color bar graph indicates pulse strength as determined by the oximeter. The bar graph changes color based upon the strength of the pulse. The color and height of the Pulse Strength Bar Graph is proportional to the pulse amplitude. For a low pulse amplitude, the device goes into High Priority Alarm mode. Green = a good pulse strength Amber = a marginal pulse strength Red = a non-discernible pulse strength, high priority alarm. The Pulse Strength / Battery Capacity Bar Graph LED indicates the battery capacity in 10% increments. Amber represents the depleted capacity of the battery and green indicates the available battery capacity. Pulse Quality LED This LED blinks to indicate an inadequate pulse quality. If there is a sustained series of inadequate pulses, the Pulse LED will illuminate solid. Pulse Volume LED This amber LED indicates that the device is in Pulse Volume Program mode. When this LED is lit, pulse volume can be adjusted using the Plus (+) and Minus (-) buttons on the front panel. The highest volume is 15, and the lowest volume is 0. The default volume level is 4. The device beeps while pulse volume is being changed, showing the volume progression as it is adjusted. Auto NIBP Mode LED This multicolor LED indicates that the device is in Auto NIBP mode when it is lit green. When lit amber, this LED indicates that the device is in Auto NIBP Cycle Time Program mode. The cycle time can be adjusted using the Plus (+) and Minus (-) buttons. 7
Displays, Indicators, and Controls mmhg Display Panel LED Indicators Display panel LED indicators display whether or not the Avant 2120 is functioning in certain modes (NIBP History Display mode or Initial Cuff Pressure Display mode). Battery LED This amber LED indicates a marginal battery capacity by blinking in sync with the Main Alarm LED indicator. This LED, when lit solid, indicates that the battery capacity is being displayed. This LED does not indicate that the Avant 2120 is running on battery power. WARNING: The battery pack must be installed at all times while the device is operating, even when operating on AC power. The audible alarms and memory will not function if batteries are removed from the device. Do NOT use the device without batteries. AC Power Supply LED This green LED is displayed when an external power supply is providing power to the device. Alarm Silence LED This amber LED indicates that the audible alarm is temporarily silenced when it blinks. When lit solid, the Alarm Silence LED indicates that the audible alarm volume is set to zero. Main Alarm LED The Main Alarm LED indicates visible alarm conditions. A rapid blinking red main alarm LED indicates high priority; medium priority alarm condition is indicated by a slowly blinking amber main alarm LED. Alarm Volume LED This amber LED indicates that the device is in Alarm Volume Program mode. When this button is illuminated, the alarm volume can be adjusted by using the Plus (+) and Minus (-) buttons on the front panel. The highest volume is 15, and lowest volume is 8. The default volume level is 8. If DIP switch 2 is moved to the UP position, then the alarm volume can be adjusted to zero. Time, Month, Day, and Year LEDs These amber LEDs indicate that the Time, Month, Day, or Year displays can be reviewed or adjusted using the Plus (+) and Minus (-) buttons. 8
Displays, Indicators, and Controls Display Panel Buttons NIBP Button This button is used to begin or cancel a single blood pressure measurement. While the device is taking a blood pressure reading, pressing any button on the front panel will cancel the action and deflate the cuff. Auto NIBP Cycle Time Button This button is used to display the automatic blood pressure measurement cycle time. The Plus (+) and Minus (-) buttons are used to change the cycle time setting. The device can be set to start a blood pressure reading every 1, 2, 3, 5, 10, 15, 30, 45, 60, or 90 minutes after the previous blood pressure reading is complete. The NIBP timer begins after the previous blood pressure measurement is completed. NIBP History Review Button This button displays previously measured blood pressure values. The Plus (+) and Minus (-) buttons can be used to scroll through and display stored NIBP readings. By using the NIBP History Review Button, the last 300 readings may be reviewed. Readings are not lost when the device is in Standby mode. Readings from previous sessions are indicated with a blinking time stamp. mmhg Initial Cuff Pressure Button This button displays the initial cuff inflation pressure (i.e., the amount of pressure to which the cuff initially inflates) when obtaining a reading. The inflation pressure will readjust, based on the patient s previous blood pressure. The initial cuff pressure can be changed using the Plus (+) and Minus (-) buttons. Initial cuff pressure can be set to 120, 140, 160, 180, 200, 220, or 240 mmhg. ON/STANDBY Button This button toggles the device between ON and STANDBY modes. Pressing this button once turns on the device. Pressing and holding this button for at least 1 second turns off the device. Briefly pressing this button while the device is on displays the battery capacity, in 10% increments. Amber represents the depleted capacity of the battery and green indicates the available capacity. If the ON/ STANDBY button is pressed again, the battery capacity display exits. The battery capacity display will exit automatically after four seconds. 9
Displays, Indicators, and Controls Alarm Silence Button This button toggles the alarm between silenced and audible. Pressing the Alarm Silence button silences all alarms for two minutes. Pressing and holding this button for two seconds clears all NIBP high and medium priority alarms (including any displayed NIBP data). Limits Button This button displays the upper and lower limits for alarm indications for SpO 2, heart rate, systolic, diastolic, and MAP measurements. These limits can be adjusted using the Plus (+) and Minus (-) buttons. The upper LED indicates the upper alarm limit is being displayed, and the lower LED indicates the lower alarm limit is being displayed. The limit values are displayed in amber. Plus and Minus Buttons The Plus and Minus buttons are used to adjust timing of automatic blood pressure readings, initial cuff pressure, time, date, volume, upper and lower alarm limits, and they are used to scroll through the NIBP history. Pressing this button, when the device is not in program mode, adjusts the intensity of the LED displays. Time/Date Button This button displays the time and date. Pressing the button allows the user to set the year, month, day, hour, and minute, with the Plus (+) and Minus (-) buttons. In US mode, pressing the button allows the user to set the year, month, day, hour, and minute with the Plus (+) and Minus (-) buttons. Placing DIP switch 3 in the UP position allows users to view and set the time and date in International mode. Volume Button This button displays the pulse volume and alarm volume, identified by the illuminated LED. The pulse and alarm volumes can be adjusted using the Plus (+) and Minus (-) buttons. 10
Operating the Device Operating the Device Installing the Batteries WARNING: The battery pack must be installed at all times while the device is operating, even when operating on AC power. The audible alarms and memory will not function if batteries are removed from the device. Do NOT use the device without batteries. Figure 2: Installing the Batteries Remove the back cover by loosening the screws. Insert the battery pack as illustrated. Reposition the back cover carefully and tighten the screws firmly, do not over-tighten. Removing batteries from the device deletes all previous oximetry and NIBP data; it does not delete user-defined alarm limits. 11
Operating the Device Verifying Operation Press the ON/STANDBY button to perform the start-up (initialization) sequence. Verify that all LEDs, except the AC Power Supply LED, are illuminated and the unit beeps three times during the start-up sequence. If any LED is not lit, do not use the device and contact Nonin Technical Service for assistance. Use the following procedure to verify that the pulse oximeter sensor is functioning properly. 1. Ensure the device is on and the sensor is connected to the monitor. 2. Apply the pulse oximeter sensor to the patient. 3. Verify SpO 2 and pulse rate values are displayed, and the pulse strength bar graph LED is activated. Alarm Limit Defaults During initialization, FAC DFL or USR DFL will appear briefly in the SpO 2 and Pulse Rate displays to indicate which defaults are in use; after initialization, any of the defaults can be modified. To program user-defined alarm limit and volume defaults, set DIP switch 8 to the UP position. A value for each limit must be programmed before the device will continue to operate. To return to factory defaults, DIP switch 8 must be set in the DOWN position before entering start-up initialization. NOTE: The device must be in factory default mode before programming user-defined alarm limit and volume defaults. NIBP and %SpO 2 Functions The NIBP and %SpO 2 functions on the Avant 2120 can be used separately or simultaneously. To take %SpO 2 measurements, ensure that the device is on with a Nonin-branded PureLight sensor connected to the monitor. Apply the sensor, following the Instructions for Use provided with the sensor. SpO 2 and pulse rate measurements will be displayed in the %SpO 2 and Pulse Rate displays. WARNING: This device must be able to measure the pulse properly to obtain an accurate SpO 2 measurement. Verify that nothing is hindering the pulse measurement before relying on the SpO 2 measurement. 12
Operator Functions Operator Functions Taking Blood Pressure Measurements This section describes how to take blood pressure measurements with the Avant 2120. NIBP Cuff Selection To obtain accurate readings, the appropriate cuff size must be selected for each patient. Contraindication: The blood pressure monitor is not intended for use with neonates. WARNING: Use only Nonin-specified blood pressure cuffs and hoses with the device. Using other cuffs might result in inaccurate readings or inability to operate the device.. Small Adult BP Cuff Standard Adult BP Cuff Large Adult BP Cuff Extra Large Adult BP Cuff 18-26 cm arm circumference 26-35 cm arm circumference 32-42 cm arm circumference 35-44 cm arm circumference NIBP Cuff Placement Apply the cuff around the bicep of the left or right arm slightly above the elbow, so the inflation bladder is centered over the brachial artery (the inflation bladder is approximately half of the entire length of the cuff). Do not apply the blood pressure cuff to an arm with an IV. The patient s arm should be resting comfortably, at a level that is parallel to his or her heart, with the palm of the hand facing upward. If a comfortable fit is difficult to obtain, a different cuff size might be required. Blood pressure cuffs should be applied directly to the patient s skin; applying cuffs over clothing may affect the blood pressure measurements. Patients should be in a relaxed position with feet flat on the floor (if sitting). Do not apply the blood pressure cuff to the same arm the pulse oximeter sensor is applied. WARNING: To obtain accurate results, and for important safety reasons, the blood pressure cuff must only be placed on the patient s arm. 13
Operator Functions Figure 3: Proper Cuff Placement Use the following procedure to take blood pressure and/or SpO 2 measurements: NOTE: If the device is turned on without an oximeter sensor, the oximeter will be disabled and the SpO 2 display will remain blank. Plugging in the oximeter sensor at any time will enable the oximeter. 1. Ensure that the device is on and the start-up sequence is complete. 2. Connect the blood pressure cuff and/or pulse oximeter sensor to the device. Attach the straight or coiled tubing to the monitor; attach the cuff to the tubing as illustrated below. Connect the pulse oximeter sensor as illustrated below, with the Nonin logo facing up. 14
Operator Functions Figure 4: Connecting the Blood Pressure Cuff and Finger Clip Sensor 3. Place the blood pressure cuff around the patient s arm. 4. Apply the finger clip sensor on the patient (see Sensor Instructions for Use for proper placement). 5. Press the NIBP button to begin a single blood pressure measurement. The cuff will begin inflating, and the cuff pressure value will appear in the Time LED display. 6. When the reading is complete, the Systolic, Diastolic, and MAP numeric LEDs will display the results for blood pressure. If pulse rate and SpO 2 readings are not obtained from the oximeter sensor, the pulse rate reading from the NIBP will be displayed. NOTE: When the finger clip sensor is applied, the %SpO 2 and pulse rate readings are from the Finger Clip sensor, not the blood pressure measurement. NOTE: If a blood pressure reading must be cancelled for any reason, press any button, except the Alarm Silence button, to deflate the cuff. Automatic and Demand NIBP Measurements The Auto NIBP Cycle Time button is used to begin or end timed blood pressure measurements and display the Auto NIBP Cycle time, which can be adjusted using the Plus (+) and Minus (- ) buttons. Blood pressure readings can be started every 1, 2, 3, 5, 10, 15, 30, 45, 60, or 90 minutes after the previous reading is complete. 15
Operator Functions When continuous spot-checking of patients is required or to determine fluctuations in blood pressure over periods of time, the Automatic NIBP should be used. Demand NIBP measurements are single-time measurements taken by pressing the NIBP button on the device. Calibrating Blood Pressure Calibration should be performed after every 10,000 inflations or once per year, using the following procedure. Calibration should only be performed by qualified personnel. Suggested Equipment: Mercury Manometer Pneumatic T-Adapter Pressure Bulb 1. With the device turned off, connect a mercury manometer and pressure bulb to the device using a T-adapter. 2. Using the tip of a screwdriver or other similar device, place DIP switch 1 in the UP position. 3. Turn on the device. A CAL message is displayed in the Systolic display window, verifying that the device is in Calibration mode. 4. Wait for a green 0 to appear in the Diastolic LED display. 5. Verify that the pressure on the manometer is zero, so there is no pressure difference at the pressure transducer and outside the device. 6. Press the NIBP button. A countdown will begin, followed by 250 in the Diastolic display. 7. Using the pressure bulb, apply exactly 250 mmhg to the device. 8. Press the NIBP button to calibrate the device at 250 mmhg. The device is now calibrated and will display a CAL dne message. 9. Press the ON/STANDBY button to turn the device off. 10. Return DIP switch 1 to the DOWN position. NOTE: The pulse oximeter does not require calibration. 16
Advanced Features Advanced Features This section describes the advanced features available on the Avant 2120. Button Combinations This device offers two advanced features that are available by using multiple button combinations. The device must be in Standby mode before using either of the advanced features. Button Combination + + Feature Name Retain Previous User-Defined Volume and Alarm Limits Clear Oximeter Memory Function Allows users to retain the previously set user-defined alarm and volume limits even after shutting down the device. To use this feature, hold the Limits button while pressing the ON/STANDBY button to power the device. Allows users to clear the oximeter memory. To use this feature, hold the NIBP History Review button while pressing the ON/ STANDBY button to power the device. NOTE: If the Limits button and NIBP History Review button are both held while pressing the ON/STANDBY button to turn on the device, both of the above advanced features are active. DIP Switches The DIP switches are located under the blue battery cover on the rear of the device. A small Phillips screwdriver must be used to remove the battery cover. The default for all switches is the DOWN position. Table 2. DIP Switches Switch Function 1 UP: Calibration Mode DOWN: Normal Operation (Default) 2 Alarm Disable/Minimum Alarm Volume Definition: See Silencing Alarms for more information. UP: 0 db DOWN: 45 db (Default) 3 UP: International Date Format DOWN: USA Date Format (Default) 17
Advanced Features Table 2. DIP Switches (Continued) Switch Function 4 UP: Real-time data output available via RS232 port DOWN: Print-on-Demand mode activated (Default) 8 UP: User-Defined Alarm Limit and Volume Defaults DOWN: Factory Alarm Limit and Volume Defaults (Default)! CAUTION: Do not place DIP switch 1 in the UP position unless device calibration is intended. 1 2 3 4 5 6 7 8 Figure 5: DIP Switches 18
Advanced Features Quick Reference for Printing The Avant 2120 features printing capabilities that allow you to print on demand or in real-time. These are controlled by DIP switch 4, which is located under the battery cover at the back of the device. When DIP switch 4 is in the UP position, real-time (once per second) data output is available via the RS232 connector port, using a null modem cable. When DIP switch 4 is in the DOWN position (default), the Print-on-Demand mode is activated, allowing you to print via the RS232 connector port only when desired. There are three ways to print when the device is in Print-on-Demand mode: Print-On-Demand Press Printout Normal Mode Prints displayed data. History Mode Prints displayed history data. Auto NIBP Mode Prints displayed data and automatically prints all new displayed data upon completion of NIBP reading. NOTES: Event markers are not available in Print-On-Demand mode. Data must be allowed to finish printing before entering History Review mode. When there is invalid NIBP data, BP=Error will print in place of SYS=XXX DIA=XXX MAP=XXX for all Print-On-Demand formats. Valid SpO 2 and heart rate data will continue to be displayed in the event of an NIBP error code. Print functions are available only with a 9600 baud serial ASCII printer. The device has a Memory Download feature, allowing stored data to be transferred to Nonin s nvision data management software for analysis. Printing features are not available during memory download. 19
Communication Communication Memory Features The Avant 2120 can collect and store up to 33.5 hours of SpO 2 and pulse rate information. Data may be downloaded with Nonin s nvision data management software. NOTE: Only SpO 2 and pulse rate data are available for download. The memory in the device functions as an endless loop tape. When the memory fills up, the device begins overwriting the oldest data with the new data. Each time the device is turned on, the current time/date information (if the clock is set properly) is stored in memory, starting a new data collection. Only data collections greater than one minute in length are stored in memory. Patient SpO 2 and pulse rate are sampled every 2 seconds. Every 4 seconds, the high and low values of the 4-second sample period is stored. Oxygen saturation values are stored in 1% increments in the range of 0 to 100%. The stored pulse rate ranges from 18 to 300 pulses per minute. The stored values are in increments of one pulse per minute in a range of 18 to 200 pulses per minute, and in increments of 2 pulses per minute in a range of 201 to 300 pulses per minute. WARNING: The battery pack must be installed at all times while the device is operating, even when operating on AC power. The audible alarms and memory will not function if batteries are removed from the device. DO NOT use the device without batteries. Using nvision Data Management Software This device has a Memory Download feature, allowing stored data to be transferred to Nonin s nvision data management software for analysis. When downloading data, use the following procedure. 1. With the device off, attach the null modem cable to the RS-2323 connector port of the device and to the back of your computer. 2. With the device still off, press and hold the NIBP History Review button while pressing the ON/STANDBY button. All LEDs will illuminate briefly. PLy will appear in the SpO 2 LED display area, and bac will appear in the Systolic display area. This message signals that the device is now in Download mode. 3. The PLy bac message will disappear after a few seconds, indicating that the memory download is complete. Pressing the ON/STANDBY button will exit Download mode. 20
Communication 4. A CLr no message will be displayed, and three informational tones will sound. Use the Plus (+) and/or Minus (-) buttons to toggle between YES and no on the Systolic display window. 5. Press the ON/STANDBY button when the desired Memory Clear selection is made. If selecting no, pressing the ON/STANDBY button exits Download mode, and normal operation resumes. If selecting YES, pressing the ON/STANDBY button displays a del message in the %SpO 2 display window and a no message in the Systolic display window. Use the Plus (+) and/or Minus (-) buttons to toggle between YES and no on the Systolic display window. NOTE: Selecting YES from the del window will permanently delete the device s memory. 6. If YES is selected, a dne CLr message appears when patient data is clear. Press the ON/STANDBY button to return to normal operation. 7. For more information about using nvision, refer to nvision's online help. NOTE: Patient oximetry and NIBP data are cleared simultaneously in Download mode. Real-Time Patient Data Output The Avant 2120 provides real-time data output capability via the RS232 connector port. A null modem cable must be connected from the device to the receiving computer. RS232 Connector Port Figure 6: RS232 Connector Port The information from the device in the real-time mode is sent in an ASCII serial format at 9600 baud with 9 data bits, 1 start bit, and 1 stop bit. The data output rate is once per second (on separate lines). 21
Communication Real-time data may be printed or displayed by devices other than the pulse oximeter. Upon start up, a header is sent identifying the format and the time and date; the data format is: SPO2=XXX HR=YYY NIBP will be displayed when it is available in the following format: SPO2=XXX HR=YYY SYS=SSS DIA=DDD MAP=MMM where XXX is the SpO 2 value, YYY is the heart rate value, SSS is the systolic value, DDD is the diastolic value, and MMM is the MAP value. When there is no oximeter data, the formats will appear as follows: SPO2=--- HR=--- SPO2=--- HR=YYY SYS=SSS DIA=DDD MAP=MMM This device includes an event marker feature. Events are indicated by a single * whenever ON/STANDBY is pressed. This feature can be used to mark patient events. The Battery Capacity will be displayed for 4 seconds when marking events. ON/STANDBY may be pressed again to exit sooner. SPO2=XXX HR=YYY* SPO2=XXX HR-YYY SYS=SSS DIA=DDD MAP=MMM* 22
Care and Maintenance Care and Maintenance The NIBP module requires calibration after every 10,000 inflations or once each year; the pulse oximeter module requires no calibration. Field repair of the device circuitry is not possible. Do not attempt to open the case or repair the electronics. Opening the case will damage the device and void the warranty. If the device is not functioning properly, see Troubleshooting or contact Nonin Technical Service. Cleaning Clean the Avant 2120 separately from the sensors. For instructions regarding cleaning pulse oximeter sensors, refer to the appropriate pulse oximeter sensor Instructions for Use. Clean the device with a soft cloth dampened with isopropyl alcohol. Do not pour or spray any liquids onto the device, and do not allow any liquid to enter any openings in the device. Allow the device to dry thoroughly before reuse. Cleaning the Blood Pressure Cuff To clean the reusable blood pressure cuff, wipe the cuff with a soft cloth dampened with isopropyl alcohol. Do not pour or spray any liquids onto the cuff, and allow the cuff to dry thoroughly before reusing it.! CAUTION: Do not autoclave or immerse this device in liquid or use caustic or abrasive cleaning agents. 23
Alarms and Limits Alarms and Limits WARNING: To comply with relevant product safety standards, ensure that all alarm volumes are set appropriately and are audible in all situations. Do not cover or otherwise hinder any speaker openings. Alarms This device provides high and medium priority audible and visual alarms. It also provides informational tones. High Priority Alarms High priority alarms require immediate attention to the patient. High priority alarms are indicated with a rapidly blinking red LED when alarm limits are met or exceeded. Low perfusion is indicated by a red segment on the pulse strength bar graph LED. High priority alarms are: 3 beeps, a short pause, 2 beeps and a 10-second pause and repeat until the alarm is cleared or silenced. Medium Priority Alarms Medium priority alarms signal potential problems with the equipment or other non-lifethreatening situations. Medium priority alarms are indicated with slowly blinking amber displays on the Main alarm LED and the appropriate indicators or numeric displays. An error code may display in the MAP area, to identify the error source. See the Error Code Table on the following page. Medium priority alarms are: 3 beeps, a 25-second pause, followed by 3 additional beep, repeated until the alarm is cleared or silenced. Error Codes This device includes various error codes to indicate potential problems with the device. The following table describes the error codes present on the Avant 2120. Table 3. Error Codes Error Code CAN E00 Description NIBP Module, User Cancelled: NIBP module was cancelled from taking blood pressure reading. System Error: Retry reading. If reading is not possible, turn the device off and on again and retry. Calibration may be required. Call Nonin Technical Service if error persists. 24
Alarms and Limits Table 3. Error Codes (Continued) Error Code E01 E02 E03 E04 E05 E06 E07 E10 E11 E13 E17 E19 E31 E32 E33 E34 E35 E36 E37 E38 E39 E40 E41 E42 E43 NIBP Module, Bad Signals: NIBP module cannot complete reading. Failure could be due to patient s blood pressure falling outside module s range. Check patient, air hose connection, and cuff application. NIBP Module, Overpressure: Overpressure condition occurred. NIBP Module, Air Leak: Check hose and cuff for damage or air leaks. NIBP Module, Blockage in Hose: Check hose for kinks or blockage. NIBP Module, Safety Timeout: Allowed time expired before reading was complete, or system remained in test mode for more than three minutes. NIBP Module, Excessive Motion: Check patient, reduce motion. NIBP Module, Transducer Out of Range: NIBP module pressure transducer may need recalibration. NIBP Module, Calibration Data Invalid NIBP Module, ADC Hardware Failure NIBP Module, Pressure Calibration Failed: Module unable to reset pressure calibration data. Undefined NIBP Error NIBP Module, No Communication: No data from NIBP module. Sound Error: Channel 1 Failure Sound Error: Channel 2 Failure Sound Error: Both Channels Failure Sound Error: Amplifier Failure Sound Error: Channel 1 Failure, Amplifier Failure Sound Error: Channel 2 Failure, Amplifier Failure Sound Error: Channel 1 Failure, Channel 2 Failure, Amplifier Failure Sound Error: Speaker Failure Description Sound Error: Channel 1 Failure, Speaker Failure Sound Error: Speaker Failure, Channel 2 Failure Sound Error: Channel 1 Failure, Channel 2 Failure, Speaker Failure Sound Error: Speaker Failure, Amplifier Failure Sound Error: Channel 1 Failure, Speaker Failure, Amplifier Failure 25
Alarms and Limits Table 3. Error Codes (Continued) Error Code E44 E45 E51 E52 E53 Description Sound Error: Speaker Failure, Channel 2 Failure, Amplifier Failure Sound Error: Channel 1 Failure, Channel 2 Failure, Speaker Failure, Amplifier Failure Sound Module, Communication Failure: No SPI communication from sound module to display board microcontroller. SCI Communication Error: SCI communication problem. External Memory Failure: External (patient data) memory failed test. Watchdog Alarm Watchdog alarms are loud, two-tone, steadily beeping signals that indicate a hardware or software malfunction. When a watchdog alarm is activated, it can be cleared by shutting down the device (press and hold the ON/STANDBY button for one second). If the watchdog alarm does not clear, contact Nonin Technical Service. Informational Tones Informational tones include the startup/initialization tone and the pulse rate tone (which changes in pitch with SpO 2 values). They are typically single beeps or a series of 3 beeps. Alarm Summary If patient readings meet or exceed the upper alarm limit, or if they meet or are below the lower alarm limit, the device will signal a high priority alarm. Table 4. Alarm Summary Alarm Description Adjustment Range Default SpO 2 Upper Alarm Limit Off, 80 to 100 by 1% Off SpO 2 Lower Alarm Limit Off, 50 to 95 by 1% 85% Pulse Upper Alarm Limit Off, 75 to 275 by 5 BPM 200 BPM Pulse Lower Alarm Limit Off, 30 to 110 by 5 BPM 50 BPM Systolic Upper Alarm Limit Off, 75 to 240 by 5 mmhg 200 mmhg Systolic Lower Alarm Limit Off, 50 to 150 by 5 mmhg 60 mmhg Diastolic Upper Alarm Limit Off, 50 to 180 by 5 mmhg 120 mmhg Diastolic Lower Alarm Limit Off, 25 to 125 by 5 mmhg 30 mmhg 26
Alarms and Limits Table 4. Alarm Summary (Continued) Alarm Description Adjustment Range Default MAP Upper Alarm Limit Off, 70 to 200 by 5 mmhg 150 mmhg MAP Lower Alarm Limit Off, 25 to 125 by 5 mmhg 50 mmhg Setting and Changing Volume and Alarm Limits NOTE: The alarm limits automatically reset themselves to default values each time the device is turned on. To retain previously adjusted alarm limits, hold the Limits button while turning on the device. Setting or Changing SpO 2 and/or Pulse Rate Alarm Limits 1. Press the Limits button; the upper amber LED is illuminated on the Limits button. OFF, default value, is displayed in the %SpO 2 display. 2. Use the Plus (+) and Minus (-) buttons to adjust the upper SpO 2 limit to the appropriate value. 3. When the appropriate upper alarm limit is displayed, press the Limits button to set the lower alarm limit. Press the Limits button 10 times to exit this mode; the device will automatically exit this mode after 10 seconds of no activity. Setting or Changing Systolic, Diastolic, and MAP Alarm Limits 1. Press the Limits button 5 times; the upper amber LED is illuminated on the Limits button, and 200, default value, is displayed in the Systolic display. 2. Use the Plus (+) and Minus (-) buttons to adjust the systolic upper alarm limit to the appropriate value. 3. When the appropriate upper alarm limit is displayed, press the Limits button to set the lower alarm limit. Press the Limits button 6 times to exit this mode; the device will automatically exit this mode after 10 seconds of no activity. Setting or Changing Alarm and Pulse Volumes 1. Press the Volume button; the Alarm Volume LED illuminates and 08, default value, appears on the display screen. 2. Use the Plus (+) and Minus (-) buttons to adjust the alarm volume to the appropriate level; Alarm Volume range is 08-15. 3. When the appropriate alarm volume is displayed, press one of the following: Volume button once to set the Pulse Volume. Volume button twice to exit Set/Change Alarm Volume mode. Wait 10 seconds to automatically exit Set/Change Alarm Volume mode. 27
Alarms and Limits Silencing Alarms To silence alarms for two minutes, press the Alarm Silence button. To permanently silence all alarms, DIP switch 2 must be placed in the UP position. This allows the Alarm Volume to be set to zero. The Alarm Silence LED will remain illuminated when the alarm volume is set to zero. WARNING: To comply with relevant product safety standards, ensure that all alarm volumes are set appropriately and are audible in all situations. Do not cover or otherwise hinder any speaker openings. Setting and Changing NIBP Settings Setting or Changing Automatic NIBP Cycle Time 1. Press the Auto NIBP Cycle Time button. The Auto NIBP LED illuminates and OFF, default value, appears on the display screen. 2. Use the Plus (+) and Minus (-) buttons to adjust the automatic NIBP cycle time, in minutes, to the appropriate intervals. 3. When the appropriate cycle time is displayed, either press the Automatic NIBP Cycle Time button once to exit this mode, or simply wait 10 seconds to automatically exit this mode. Setting or Changing Initial NIBP Cuff Inflation Pressure 1. Press the Initial Cuff Pressure button; the default cuff pressure (typically 160) appears as an LED display. 2. Press the Plus (+) and Minus (-) buttons to adjust the initial NIBP cuff inflation pressure to the appropriate level. Users may select initial pressures of 120, 140, 160, 180, 200, 220, or 240. 3. When the appropriate inflation pressure is displayed, either press the Initial Cuff Pressure button once to exit this mode, or wait 10 seconds to automatically exit this mode. 28
Parts and Accessories Parts and Accessories For more information about Nonin parts and accessories: See the Parts and Accessories List on the Operator s Manual CD. Contact your distributor or Nonin at (800) 356-8874 (USA and Canada), +1 (763) 553 9968, or +46 650 401500 (Europe). Visit www.nonin.com. WARNING: The use of accessories other than those specified in the Parts and Accessories List may result in increased electromagnetic emission and/or decreased immunity of this device. WARNING: Use only Nonin-branded PureLight pulse oximeter sensors. These sensors are manufactured to meet the accuracy specifications for Nonin pulse oximeters. WARNING: Use this device only with Nonin-specified power supplies. 29
Service, Support and Warranty Service, Support and Warranty WARNING: This device is a precision electronic instrument and must be repaired by qualified technical professionals. Field repair of the device is not possible. Do not attempt to open the case or repair the electronics. Opening the case may damage the device and void the warranty. The Avant 2120 Pulse Oximeter module performs all computations from internal software stored in microprocessor chips. Thus, there are no critical parts to drift, and no calibration of the pulse oximeter module is required. The Avant 2120 NIBP module should be calibrated after every 10,000 checks or once per year, whichever comes first. For information about the Avant 2120 and accessories, contact your local sales representative or distributor. For the sales representative or distributor in your area, contact Nonin at (800) 356-8874. A return authorization number is required before returning any product to Nonin. To obtain this return authorization number, contact Nonin s Technical Service Department at: Nonin Medical, Inc. 13700 1st Avenue North Plymouth, Minnesota 55441-5443 USA (800) 356-8874 (USA and Canada) + 1 (763) 553-9968 Fax: + 1 (763) 553-7807 E-mail: technicalservice@nonin.com www.nonin.com Nonin Medical AB Fibervägen 2 82450 Hudiksvall, Sweden +46 650 401500 (Europe) Fax: +46 650 401514 E-mail: serviceintl@nonin.se www.nonin.com Warranty NONIN MEDICAL, INCORPORATED (Nonin) warrants to the purchaser, for a period of one year from the date of purchase, each Avant 2120 battery pack, and for two years from the date of purchase each blood pressure module. Nonin warrants the pulse oximetry module of the Avant 2120 for a period of three years from the date of purchase, and the blood pressure cuff for a period of 90 days from the date of purchase. 30